THEATRE SAF E T Y
laparoscopy, and using equipment designed to capture excess smoke, this risk can be significantly reduced.
According to the BJS Society, infection risks can be reduced by ensuring evacuation devices are utilised, functioning adequately and used systematically, with a low possibility of a leak during the laparoscopic procedure. (Examples of such technology include the Cooper Surgical SeeClear.)5 It is also important to note that laparoscopic surgery is associated with reduced morbidity, shorter hospital stays and quicker return to daily activities, as the Royal College of Obstetricians and Gynaecologists (RCOG) and British Society for Gynaecology Endoscopy point out in their joint statement. At a time where every available resource is being called upon to help manage COVID-19, laparoscopic surgery could be a means of reducing the length of hospital stays and, therefore, enable staff to be deployed elsewhere as required. Further down the line, as more operations
return, the need for swifter completion and shorter hospital stays will become vital. While laparoscopy is an example of how
to meet this challenge, safety and quality standards must still be the highest priorities.
Approximately four months on from the statement’s publication, laparoscopic procedures have continued. Yet the manner in which they are being conducted has changed, possibly for the foreseeable future. With the situation surrounding COVID-19 constantly evolving, the BSGE has devised its own set of guidelines for safe operation, covering but limited to6
:
lMaintaining safety by wearing PPE. lMinimum number of staff members present.
lPaying close attention to prevent explosive dispersal of bodily fluids.
lLimiting incisions where possible, while ensuring leakage of bodily fluid is minimised.
In the case of gynaecology procedures that carry a risk of bowel involvement, it has been recommended that a laparotomy should be carried out or the procedure deferred, due to cases of the COVID-19 virus being found within faeces.6
In the case of gynaecology procedures that carry a risk of bowel involvement, it has been recommended that a laparotomy should be carried out or the procedure deferred, due to cases of the COVID-19 virus being found within faeces.
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Reducing risk and the need for repeat procedures to ease case backlog
As the number of COVID-19 cases continues to decline, surgical theatres will face a new obstacle – a backlog of procedures which may have been placed on hold while the pandemic was at its peak. This switches the focus again to efficiency and a need to clear this backlog as swiftly as possible which, as of 10 June, was already at four million patients waiting for routine procedures, with 28.4million cases cancelled worldwide.7 During the month of April, as hospitals tried to find a balance between managing COVID-19 and providing other in-demand services, urgent cancer treatment procedures were down 60%. In addition, the number of upper gastrointestinal cancer treatments fell to roughly a third compared to this time last year and treatment for those showing lower gastrointestinal cancer symptoms fell by 63%.8 Patients waiting for rescheduled surgery in these areas are also at risk of their condition worsening the longer they are on the list. Easing this backlog will take months. A return to ‘normal’ operations within the NHS will not be instantaneous either, particularly as many Trusts will continue to operate at a reduced capacity for some time.9
And there
is still the possibility of a second peak of COVID-19. However, hospitals are starting to build the necessary infrastructure to manage a second wave, if it arrives. That is not to say the pandemic is over; merely hospitals are perhaps better prepared than they were at the start of the outbreak.
This has been the result of a variety of AUGUST 2020
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